A new @TheLancet viewpoint by an international panel on boosters: "To date, none of these studies has provided evidence of substantially declining protection against severe disease." …s-jbs-prod-cdn.jbs.elsevierhealth.com/pb-assets/Lanc… But that'll change w/ this week's @NEJM Israel report, Pfizer💉, age >60
This is where I disagree w/ the panel. Many studies on reduced efficacy have been published in the media & preprints. Waiting for "robust data" that is adjudicated by the eminent authorities is not how it works. The public wants to know, has a right to know, and that builds trust
The 3 @CDCMMWR reports were concordant for reduced vaccine effectiveness vs hospitalizations for people over age 65, by 10-15 per cent points, during the US Delta wave. Another issue unaddressed by the Lancet viewpoint.

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More from @EricTopol

15 Sep
3 new @NEJM papers today on @pfizer/@BioNTech_Group vaccine
1. 3rd shot (Booster) in over 1.1 million Israelis, age ≥ 60, > 12 days later
19.5-fold reduction in severe illness
nejm.org/doi/full/10.10… ImageImage
2. 6-month follow-up of the original placebo-controlled trials (adult + teens; > 44,000 participants) showed gradual reduction in efficacy vs symptomatic infections from 96% (fully vaxxed) to 83% (> 4 months)
nejm.org/doi/full/10.10… Image
3. Small 3rd shot-> Neutralizing antibody study vs Wild-type and Delta by age group, showing significant increase immune response not much affected by variant or age Image
Read 4 tweets
15 Sep
The @pfizer @US_FDA booster documents fda.gov/media/152161/d…
reviews all data on effectiveness (VE) vs infection
—waning immunity not related to Delta, just a matter of time, 6% reduction of VE every 2 months
—restoration to 95% VE by 3rd shot
—recommends booster for all age 16+ Image
The (Pfizer) bottom line, w/ antibody % safety data in this 53 page report.
Their case is not made sufficiently for all age groups, predominantly relying on infections, not protection from severe illness, which exists now for age ≥ 60
That may change with ongoing follow-up data. Image
Little evidence of difference in booster effect by age or variant (WT/Wuhan vs Delta/DA)) difference for neutralization assays. Substantial increase on this log-scale NT50 plot across the board. Image
Read 4 tweets
14 Sep
Let me be clear about the evidence on 3rd shots. It is unequivocal for Pfizer's vaccine, given w/ 3 week spacing. In people over age 60, there is significant reduction of effectiveness (VE) vs hospitalizations and symptomatic infections at 5+ months after primary vaccination. /1
And that Israel's data shows that VE vs severe illness is restored by a 3rd shot for those age ≥ 60.
The duration of the restored VE can be debated, but likely several months, at minimum. /2
It's not the "general population" but there are over 70 million Americans age ≥ 60. They should not be sitting vulnerable while infighting takes place /3
Read 8 tweets
10 Sep
3 new @CDCMMWR reports today provide very strong reassurance of vaccination benefits vs Delta and point toward a potential edge of @Moderna_tx for real-world effectiveness washingtonpost.com/health/2021/09… by @bylenasun and @JoelAchenbach
The data from 13 US jurisdictions to show some increase in breakthrough cases during Delta but, at the same time, increased gradient of benefit for vaccination and very little rise in the fully vaccinated for hospitalizations or deaths
The Table from the report on vaccine effectiveness from 9 state analysis for reduction in emergency department, urgent care, and hospitalizations
Read 4 tweets
9 Sep
What's good and not good about @POTUS's new Covid plan
Good: major 💉mandates for 17 million health care workforce, Fed & private co employees. Discounts on rapid home tests.
Not Good:
—No data mess fix
—No Green Pass: air, rail, public transport; access to many activities
—No free, ample supply of rapid home tests, medical-grade masks to all households. 35% off a $10+/test is unhelpful
—Lack of frequent (qd or qod),free testing for all schools
—No mention of priority to get a universal #SARSCoV2 vaccine or nasal vaccine
—Fuzzy ?? booster program
—Continued lack of recognition of Prior Covid to = 1 dose of vaccine (important for Green pass/CDC cards)
—A vaccine-centric, lack attention to data deficiency, soft package that is not the aggressive "path out of the pandemic" that we need now.
Read 4 tweets
6 Sep
Looking for any favorable signs?
Hospitalizations are coming down a bit.
Case growth has flattened (log scale)
Test positivity is coming down w/ testing up.
Hoping for descent from Delta soon. ImageImage
These indices preceded the holiday weekend but pervasive pessimism prevails. Image
Maybe you'll believe @trvrb with this elegant analysis
Read 4 tweets

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